Provider Demographics
NPI: | 1760434096 |
---|---|
Name: | WRIGHT, DEBORAH MARIE (PH D) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | DEBORAH |
Middle Name: | MARIE |
Last Name: | WRIGHT |
Suffix: | |
Gender: | F |
Credentials: | PH D |
Other - Prefix: | |
Other - First Name: | DEBORAH |
Other - Middle Name: | MARIE |
Other - Last Name: | ROTHWEIL |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | |
Mailing Address - Street 1: | MU ASSESSMENT AND CONSULTATION CLINIC |
Mailing Address - Street 2: | 205 LEWIS HALL |
Mailing Address - City: | COLUMBIA |
Mailing Address - State: | MO |
Mailing Address - Zip Code: | 65211-0001 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 573-882-5092 |
Mailing Address - Fax: | 573-884-3399 |
Practice Address - Street 1: | MU ASSESSMENT AND CONSULTATION CLINIC |
Practice Address - Street 2: | 205 LEWIS HALL |
Practice Address - City: | COLUMBIA |
Practice Address - State: | MO |
Practice Address - Zip Code: | 65211 |
Practice Address - Country: | US |
Practice Address - Phone: | 573-884-0377 |
Practice Address - Fax: | 573-884-3399 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-05-16 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MO | PY01743 | 103T00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 103T00000X | Behavioral Health & Social Service Providers | Psychologist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MO | 10856751 | Other | CAQH PROVIDER # |
MO | 70637 | Medicare ID - Type Unspecified |